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Vitamin D, Parathyroid Hormone and the Metabolic Syndrome in Middle European Journal of Endocrinology (2009) 161 947–954 ISSN 0804-4643 CLINICAL STUDY Vitamin D, parathyroid hormone and the metabolic syndrome in middle-aged and older European men David M Lee, Martin K Rutter1, Terence W O’Neill, Steven Boonen2, Dirk Vanderschueren3, Roger Bouillon4, Gyorgy Bartfai5, Felipe F Casanueva6,7, Joseph D Finn, Gianni Forti8, Aleksander Giwercman9, Thang S Han10, Ilpo T Huhtaniemi11, Krzysztof Kula12, Michael E J Lean13, Neil Pendleton14, Margus Punab15, Alan J Silman, Frederick C W Wu16 and the European Male Ageing Study Group ARC Epidemiology Unit, The University of Manchester, Manchester M13 9PT, UK, 1Manchester Diabetes Centre, The University of Manchester, Manchester, UK, 2Division of Gerontology and Geriatrics and Centre for Musculoskeletal Research, Department of Experimental Medicine, 3Department of Andrology and Endocrinology and 4Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium, 5Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary, 6Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain, 7CIBER de Fisiopatologı´a Obesidad y Nutricio´n (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain, 8Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy, 9Reproductive Medicine Centre, Malmo¨ University Hospital, University of Lund, Malmo¨, Sweden, 10Department of Endocrinology, Royal Free and University College Hospital Medical School, Royal Free Hospital, Hampstead, London, UK, 11Department of Reproductive Biology, Imperial College London, Hammersmith Campus, London, UK, 12Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland, 13Department of Human Nutrition, University of Glasgow, Glasgow, UK, 14Clinical Gerontology, The University of Manchester, Hope Hospital, Salford, UK, 15Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia and 16Department of Endocrinology, Manchester Royal Infirmary, The University of Manchester, Manchester, UK (Correspondence should be addressed to D M Lee; Email: [email protected]) Abstract Objectives: Low serum 25-hydroxyvitamin D (25(OH)D) and elevated parathyroid hormone (PTH) levels have been linked to insulin resistance, the metabolic syndrome (MetS) and its components. Data in healthy, community-dwelling Europeans are lacking, and previous studies have not excluded subjects receiving drug treatments that may distort the relationship between 25(OH)D/PTH and MetS. The aim of our analysis was to examine the association of 25(OH)D and PTH with Adult Treatment Panel III-defined MetS in middle-aged and older European men. Design: This was a population-based, cross-sectional study of 3369 men aged 40–79 years enrolled in the European Male Ageing Study. Results: After exclusion of subjects with missing data, 3069 men with a mean (GS.D.) age of 60G11 years were included in the analysis. Age-adjusted 25(OH)D levels were inversely associated with waist circumference, systolic blood pressure (BP), triglycerides, and glucose (all P!0.01). Age-adjusted PTH levels were only associated with waist and diastolic BP (both P!0.05). After adjusting for age, centre, season and lifestyle factors the odds for MetS decreased across increasing 25(OH)D quintiles (odds ratios 0.48 (95% confidence intervals 0.36–0.64) highest versus lowest quintile; Ptrend!0.001). This relationship was unchanged after adjustment for PTH, but was attenuated after additional adjustment for homoeostasis model assessment of insulin resistance (0.60 (0.47–0.78); Ptrend!0.001). There was no association between PTH and MetS. Conclusions: Our results demonstrate an inverse relationship between 25(OH)D levels and MetS, which is independent of several confounders and PTH. The relationship is partly explained by insulin resistance. The clinical significance of these observations warrants further study. European Journal of Endocrinology 161 947–954 Introduction related to prevalent metabolic syndrome (MetS) (4), whereas US population-based data from NHANES, in 25-Hydroxyvitamin D (25(OH)D) and parathyroid which vitamin D levels were lower, indicated a marked hormone (PTH) are important physiological regulators inverse relationship between these variables (5). Both of extracellular calcium homoeostasis. A number of studies also suggested that PTH was related to prevalent recent population-based, cross-sectional studies suggest MetS in older men. There is some biological plausibility additional metabolic roles for these hormones (1–5). for these relationships because low vitamin D levels, Data from the California-based Rancho Bernardo study, and to a lesser extent elevated PTH levels, have been in which subjects have high sunlight exposure and associated with glucose intolerance and insulin resist- high vitamin D levels, indicated that 25(OH)D was not ance (6–10). q 2009 European Society of Endocrinology DOI: 10.1530/EJE-09-0496 Online version via www.eje-online.org Downloaded from Bioscientifica.com at 09/29/2021 03:46:31AM via free access 948 D M Lee and others EUROPEAN JOURNAL OF ENDOCRINOLOGY (2009) 161 Although the studies by Reis (4, 5) and others (3, 11) 500I automated sphygmomanometer (Omron Health- were population based and some were adjusted for care Ltd, Milton Keynes, UK). Height was measured several confounders including PTH and 25(OH)D levels, barefoot to the nearest 1 mm using a stadiometer subjects taking anti-hypertensive and lipid-lowering (Leicester Height Measure, SECA UK Ltd, Birmingham, medications were not excluded from these analyses. UK), and weight to the nearest 0.1 kg using an electronic We are not aware of any previous studies that have scale (SECA, model no. 8801321009, SECA UK Ltd) with specifically explored the effects of these groups of drugs subjects wearing light clothing. Each centre’s electronic on the relationship between the vitamin D/PTH axis scales and stadiometers were calibrated on a monthly and MetS, though it is possible that any associations basis. Waist circumference was measured thrice to the may potentially be distorted by medication use targeting nearest 1 mm using anthropometric tape, mid-way component parts of the MetS. between the lowest rib and the iliac crest with the The purpose of our study was to examine the cross- subject standing, and the median used to score. Current sectional associations of 25(OH)D and PTH levels with prescription and non-prescription drug use was recorded MetS in a large population-based cohort of European with participants bringing in all medications for men and to contrast the strength of any associations confirmation. after excluding those taking medications that might influence these relationships. Biochemistry Phlebotomy was performed prior to 1000 h to obtain a Methods fasting blood sample from all subjects. Processed serum K Subjects was stored and protected from light at 80 8C prior to analysis and shipped on dry ice to central laboratories The European Male Ageing Study (EMAS) is a prospective, for measurement of 25(OH)D (Katholieke Universiteit non-interventional cohort studyof male ageing in Europe. Leuven) and PTH (University of Santiago de Compos- Details regarding recruitment, response rates and assess- tela). Serum 25(OH)D levels were determined using RIA ments have been previously described (12). Briefly, non- (RIA kit: DiaSorin, Stillwater, MN, USA). Intra- and institutionalised men aged 40–79 years were recruited inter-assay coefficients of variation (CV) for 25(OH)D from municipal or population registers in eight centres: were 11 and 8% respectively. The detection limit of the Florence (Italy); Leuven (Belgium); Lodz (Poland); Malmo¨ RIA kit was 5.0 nmol/l 25(OH)D. Serum was assayed for (Sweden); Manchester (UK); Santiago de Compostela PTH using a chemiluminescence immunoassay (Nichols (Spain); Szeged (Hungary); Tartu (Estonia). For the Advantage Bio-Intact PTH assay, Quest Diagnostics, baseline survey, stratified random sampling was used Madison, NJ, USA). Intra- and inter-assay CV for PTH with the aim of recruiting equal numbers of men into each were 6 and 2.8% respectively. The detection limit of the of four age bands (40–49, 50–59, 60–69 and 70–79 chemiluminescence immunoassay was 0.16 pmol/l. years). Subjects were invited by letter to complete a short Analyses for cholesterol, high-density lipoprotein postal questionnaire and to attend for screening at a local (HDL) cholesterol and triglycerides were performed clinic. The mean adjusted response rate across the eight locally in all centres using commercially available centres was 43% (range 24–60%). The study was funded enzymatic methods. Fasting glucose was measured by the European Union, and ethical approval for the study using standard hexokinase enzymatic assays. Insulin was obtained in accordance with local institutional was assayed using quimioluminiscence (University of requirements in each centre. Santiago de Compostela). Insulin resistance was calcu- lated using the homoeostasis model assessment of insulin resistance (HOMA-IR) (14). All clinical path- Assessments ology laboratories were accredited by the relevant The postal questionnaire included items concerning national authorities and adhered to current guidelines demographic, health and lifestyle information. on Good Laboratory Practice as specified by EU Directive Subjects were asked about tobacco use
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